CHRONIC THROMBOEMBOLIC PULMONARY-HYPERTEN SION AND ITS TREATMENT WITHPULMONARY THROMBENDARTERIECTOMY

Chronic recurrent pulmonary embolism can lead to extensive pulmonary h ypertension by obstruction of the pulmonary vessels. Pulmonary thrombe ndarteriectomy is a new approach to normalizing the elevated pulmonary vascular resistance by removal of the adsorbed thrombi. Between 1992 and 1994 we have operated on 8 patients aged between 34 and 62 years. The first patient died due to extensive reperfusion edema, all others showed significant improvement in hemody namic parameters (mean pulmon ary artery pressure preop. 63 +/- 5 mmHg; postop. 30 +/- 9 mmHg; Cardi ac Index preop. 2.0 +/- 0.2 l/min; postop. 3.5 +/- 0.5 l/min; pulmonar y vascular resistance preop. 1169 +/- 75 dyn; postop. 228 +/- 55 dyn) and exercise performance (NYHA classification preop. III-IV, postop. I -II). Pulmonary thrombendarteriectomy represents an efficient method t o normalize elevated pulmonary pressure and exercise performance of pa tients with far-advanced chronic thromboembolic pulmonary hypertension .